Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | MD020773E | PA |
NPI | 1417957465 |
---|---|
Provider Name | Sam Bub |
First Address | Emmaus, PA 18049-3031 |
Second Address | Emmaus, PA 18049-3031 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 12/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0014636420001 | (05) | PA |
B33578 | (02) | PA |